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La7a k5 �, f <br />ADZ Laboratories, Inc. <br />2773 Downhill Drive Steamboat Springs, CO 80487 (800) 334-549.3 <br />Report <br />Name: A�� n U� cf✓1 Address: <br />Company: <br />E-mail: Telephone: 4?'G" <br />Copy of Report <br />Name: E-mail: <br />Company: Telephone: <br />Invoice to: <br />Name: Address: <br />Company: <br />E-mail: Telephone: <br />If sample(s) received past holding time (HT), or if insufficient HT remains to complete ES <br />analysis before expiration, shall ACZ proceed with requested short HT analyses? f 0 <br />If "NO" then ACZ will contact client for further instruction. If neither "YES" nor "NO" is indicated, ACZ will proceed with the requested analyses, even if HT is expired ddata will be qualified <br />Are samples for SDWA Compliance Monitoring? Yes No <br />If yes, please include state forms. Results will be reported to PQL for Colorado. <br />Sampler's Name: Sampler's Site Information State Zip code <br />Time Zone <br />•I attest to the authenticity and validity of this sample. I understand that intentionally mislabel <br />I.Sampler's Signature: tampering with the sample in anyway, is considered fraud and punishable by State Law. <br />ng the time/date/location or <br />PROJECT INFORMATION <br />Quote #: <br />Q <br />`� <br />Reporting state for compliance testing: p c4c <br />Ed Check box if samples include NRC licensed material? c <br />SAMPLE IDENTIFICATION 1 <br />/&'01 ae__ I -* <br />34-+4-4 <br />1 <br />AL ..tA <br />r <br />Matrix SW (Surface Water) GW (Ground Water) WW (Waste Water) DW (Drinking Water) SL (Sludge) SO (Soil) OL (Oil) <br />REMARKS <br />Other (Specify) <br />12us H a�. (Y scl r <br />-SCCTt 'fC N1��� GV>iitl�r%r�� <br />Please refer to ACZ's terms & conditions located on the reverse side of this COC. <br />REUNQUISHED 1 . <br />1 <br />j, <br />•II 11•• • <br />White - Return with sample. Yellow - Retain for your records. <br />r-dLyC LJ UI LJ <br />